title: One thousand consecutive primary liver transplants under tacrolimus immunosuppression: a 17- to 20-year longitudinal follow-up.
abstract: BACKGROUND
  Tacrolimus has proven to be a potent immunosuppressive agent in orthotopic liver transplantation (OLT). The aim of this study is to examine its long-term efficacy and safety.
  
  
  RESULTS
  One thousand consecutive primary OLTs performed between August 1989 and December 1992 and maintained under tacrolimus-based immunosuppression were followed up until January 2009. Patient and graft survivals with corresponding causes of death and retransplantation, maintenance immunosuppression, and adverse effects were examined. The study population includes 600 males and 400 females comprising 166 children, 630 adults, and 204 seniors. The mean follow-up was 17.83 (range, 16.1-19.50) years. The overall 20-year actuarial patient and graft survivals were 35.8% and 32.6%, respectively. At the last follow-up, 442 patients were alive; 133 (77.1%) children, 265 (34.5%) adults, and 44 (16.1%) seniors (P=0.0001). After the first post-OLT year, cardiopulmonary events, recurrence of primary disease, and malignancy were the main causes of death. Overall, 183 recipients underwent retransplants; mainly for primary nonfunction, hepatic artery thrombosis, and recurrent primary disease, 180 required dialysis, and 45 underwent kidney transplant. A total of 97.7% of the survivors were on tacrolimus and 26.2% were also receiving adjunctive immunosuppressants at the last follow-up.
  
  
  CONCLUSIONS
  The overall 20-year actuarial patient and graft survivals were 35.8% and 32.6%, respectively, with significantly better survival among children. Age-related complications, recurrence of primary disease, and malignancy were the major causes of late graft loss. Graft loss related to immunologic reasons was rare. The prevention of recurrent disease and newer immunosuppressive regimen will further improve these results.
authors.affiliation: Division of Abdominal Organ Transplantation, Department of Surgery, Temple University Hospital, Philadelphia, PA, USA. ashokkumar.jain@tuhs.temple.edu
authors.forename: Ashokkumar
authors.initials: A
authors.lastname: Jain
authors.forename: Ashish
authors.initials: A
authors.lastname: Singhal
authors.forename: Paulo
authors.initials: P
authors.lastname: Fontes
authors.forename: George
authors.initials: G
authors.lastname: Mazariegos
authors.forename: Michael E
authors.initials: ME
authors.lastname: DeVera
authors.forename: Thomas
authors.initials: T
authors.lastname: Cacciarelli
authors.forename: Roberto C
authors.initials: RC
authors.lastname: Lopez
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sindhi
authors.forename: Abhi
authors.initials: A
authors.lastname: Humar
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003920:Diabetes Mellitus / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016559:Tacrolimus / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus